Provider Demographics
NPI:1245612563
Name:SHEIBAR, AMY KATHERINE
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:KATHERINE
Last Name:SHEIBAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-2465
Mailing Address - Country:US
Mailing Address - Phone:810-534-6163
Mailing Address - Fax:
Practice Address - Street 1:100 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-2465
Practice Address - Country:US
Practice Address - Phone:810-534-6163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-23
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010942103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist